When 911 operators in Denver receive calls about citizens acting irrationally, mental health professionals together with paramedics are sent to investigate the incidents—not armed police officers. The city’s program is known as Support Team Assisted Response (STAR). At this stage, it’s only a pilot program, but the early results are promising, and could portend a new, game-changing paradigm for the way municipalities manage acute psychiatric illness. In the eight city precincts where the program has been implemented, minor offenses have dropped by 34%. Some of these reductions are because mental health professionals are not issuing citations leading to arrests, but the data also suggests that the actual level of minor crimes dropped as well.
Nonetheless, the STAR program is controversial. Since it’s only a pilot program, the results need to be replicated. Currently, the STAR program team only responds to non-violent conduct such as trespassing, public intoxication, minor disturbance to the peace, etc. Many of the individuals in these circumstances tend to be agitated and in some form of an altered mental state. Armed police officers are trained to vigorously and verbally assert their authority and take command of the interactions when they are dealing with individuals suspected of committing offenses. Such an approach is necessary and effective for an individual who is rational and misbehaving. With someone in an altered and possibly psychotic mental state, such an aggressive response may be experienced as dangerously threatening. As their agitation and fear escalate, the citizen’s unstable mental state frequently escalates to irrational proportions, with potentially tragic consequences. Mental health professionals are trained to establish rapport with distressed and disturbed individuals and to diffuse tensions. Together with other members of the STAR team, they can then assist in identifying the individual's psychological and psychiatric needs and direct them to appropriate psychiatric and medical resources.
As a practicing forensic neuropsychologist in Southern California, I have been asked to evaluate defendants for California's mental health diversion program. It’s structured differently than the STAR program, but with a similar goal, which is to reduce the criminalization of those who suffer from a mental illness. Here in California, if the defendant is arrested and meets the stringent criteria of the diversion program, the allegations against him or her are held in abeyance for two years, during which the defendant undergoes psychiatric treatment. During that two-year period, the defendant must participate in the prescribed treatment and remain free of any criminal offenses or violations. If they stabilize and meet the criteria, charges are dropped.
The diversion criteria are as follows. First, a court-accepted mental health expert must have evaluated the defendant and diagnosed the defendant with an identified mental disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders. (Certain personality disorders, such as antisocial personality disorder, are excluded.) In addition, the defendant’s mental disorder must have played a significant role in the commission of the offense and, in the expert's opinion, the psychiatric symptoms motivating the criminal behavior would respond to mental health treatment. Most significantly, the court must be satisfied that, as the defendant undergoes treatment, he will not pose an unreasonable risk to public safety. Additionally, the defendant must sign an agreement that they will accept treatment recommendations and waive their right to a speedy trial.
A defendant I recently evaluated for diversion was arrested and charged with battery and false imprisonment. Michael walked into a university lounge and began talking to a student whom he did not know. He bent down to hug her as she sat in her chair, and lifted her up off the chair. She screamed, which caused Michael to leave the classroom. He was picked up by campus police about a half-hour later as he was walking around campus. The alleged victim told police that Michael looked “high on drugs.” Blood tests revealed otherwise, though his appearance made it seem like a possibility. The police described him as shirtless and without shoes. He was disheveled, disoriented, and altered in his consciousness—not from drugs, but from his mental illness.
My evaluation revealed that Michael had a long history of psychiatric hospitalizations for psychotic behavior. His mother told me that he had been “going downhill” about two weeks prior to the incident. When I began my evaluation of Michael, he had been incarcerated for about two months at the local jail, during which he had been psychiatrically medicated. He was already fairly stable.
I diagnosed Michael with a schizophrenic illness, and submitted my report to the court. The judge, assistant district attorney, and defense attorney all agreed with my opinion, that he was appropriate for the diversion program. He will now be in treatment for two years and monitored by the court. The charges will be dropped if he does not violate any law or provisions of the diversion program during that period. He must follow my specific recommendations, which include weekly individual psychotherapy, group therapy, and psychiatric medication during his participation in the program. I also recommended participation in a psychiatric day treatment program for the first three months of his release from jail.
The provisions afforded by mental health care could, in my opinion, reduce crime and be a cost-effective alternative to the mass incarceration of people who are mentally ill. It might also reduce the incidence of police shootings of people who are mentally ill. The weakness of alternate programs such as our diversion program and Denver’s STAR program is that there is no systematic and structured place to provide quality psychiatric treatment during the period of time when the defendant is actively monitored by the court and in the process of psychiatric stabilization.
